Health policy and planning
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Provider-initiated partner notification for HIV effectively identifies new cases of HIV in sub-Saharan Africa, but is not widely implemented. Our objective was to determine whether provider-based HIV partner notification strategies are cost-effective for preventing HIV transmission compared with passive referral. We conducted a cost-effectiveness analysis using a decision-analytic model from the health system perspective during a 1-year period. ⋯ The costs per partner tested were $19 (provider), $9 (contract) and $4 (passive). We conclude that, in this population, provider-based notification strategies are potentially cost-effective for identifying new cases of HIV. These strategies offer a simple, effective and easily implementable opportunity to control HIV transmission.
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We introduce the 'active patient' model, which we claim is a better way to describe health-seeking behaviour in low-income countries. Active patients do not automatically seek health care at the closest or lowest cost provider, but rather seek high-quality care (even at higher cost) when they estimate that such care will significantly improves outcomes. We show how the active patient can improve his or her health even when access to adequate quality care is insufficient and that the empirical literature supports this model, particularly in Africa. Finally, we demonstrate the importance, in analysing health care policy, of recognizing patients' efforts to improve health outcomes by seeking quality care.